Disclosures: The authors report no relevant financial disclosures.
November 24, 2020
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Less sedentary time may improve rates of HF hospitalization in older women

Disclosures: The authors report no relevant financial disclosures.
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Less daily sedentary time was associated with lower rates of HF hospitalization among postmenopausal women, according to a study published in Circulation: Heart Failure.

Michael J. LaMonte

“For heart failure prevention, we need to promote taking frequent breaks from prolonged sitting or lying down, in addition to trying to achieve guideline levels of physical activity, such as those recommended by the American Heart Association,” Michael J. LaMonte, PhD, MPH, associate professor of epidemiology in the School of Public Health and Health Professions at the University at Buffalo in Buffalo, New York, said in a press release. “Very few studies have been published on sedentary time and heart failure risk, and even fewer have focused on older women in whom both sedentary behavior and heart failure are quite common.”

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For this analysis, investigators included 80,982 women (mean age, 63 years; 85% white; 6% current smokers) from the Women’s Health Initiative observational study who at baseline did not have known HF and were able to walk at least one block unassisted. Sedentary behaviors were evaluated by repeated questionnaires and categorized based on awake time spent sitting or lying down ( 6.5, 6.6-9.5 or > 9.5 hours per day). Sitting time was also independently evaluated ( 4.5, 4.6-8.5 or > 8.5 hours per day).

Sedentary time and HF hospitalization

Overall, participants reported approximately 7 hours per day of sedentary behavior and high physical functioning. About 11% reported no recreational physical activity.

Investigators observed that rates of HF hospitalization were:

  • 1.9 per 1,000 person-years with 6.5 hours per day or less of sedentary time;
  • 2.2 per 1,000 person-years with 6.6 to 9.5 hours per day of sedentary time; and
  • 2.4 per 1,000 person-years with more than 9.5 hours per day of sedentary time.

For the time-varying categories of sitting, the rates of HF hospitalization were:

  • 1.9 per 1,000 person-years with 4.5 hours per day or less of sedentary time;
  • 2.3 per 1,000 person-years with 4.6 to 8.5 hours per day of sedentary time; and
  • 2.4 per 1,000 person-years with more than 8.5 hours per day of sedentary time.

“These findings are consistent with other studies confirming that people with more daily sedentary time are more likely to develop chronic health conditions such as diabetes, high blood pressure, heart attack, stroke and premature death from heart disease and other causes,” LaMonte said in the release.

Moreover, women in the highest category for sedentary behavior time experienced a 42% (95% CI, 25-61) increased risk for HF hospitalization compared with the lowest time category. In addition, those in the highest category for daily sitting time experienced a 54% (95% CI, 34-78) greater risk for HF hospitalization compared with the lowest category.

In multivariate analyses controlling for factors such as age, race/ethnicity, income and education, compared with those in the lowest tertile of sedentary behavior, those in the middle tertile had elevated risk for HF hospitalization (HR = 1.15; 95% CI, 1.01-1.31), and those in the highest tertile had even greater risk (HR = 1.42; 95% CI, 1.25-1.61; P for trend < .001). There were similar trends when the cohort was divided by sitting time (HR for middle tertile vs. lowest = 1.14; 95% CI, 1.01-1.28; HR for highest tertile vs. lowest = 1.54; 95% CI, 1.34-1.78; P for trend < .001). The results did not change after further adjustment for MI, coronary revascularization or baseline physical activity.

‘Sit less and move more’

“Our message is simple: Sit less and move more. Historically, we have emphasized promoting a physically active lifestyle for heart health — and we should continue to do so,” LaMonte said in the release. “However, our study clearly shows that we also need to increase efforts to reduce daily sedentary time and encourage adults to frequently interrupt their sedentary time. This does not necessarily require an extended bout of physical activity; it might simply be standing up for 5 minutes or standing and moving one’s feet in place. We do not have sufficient evidence on the best approach to recommend for interrupting sedentary time. However, accumulating data suggest that habitual activities such as steps taken during household and other activities of daily living are an important aspect of cardiovascular disease prevention and healthy aging.”